0417T prior authorization | Anthem Blue Cross Blue Shield of Georgia

0417T, Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, including review and report, implantable cardiac contractility modulation system, is on the Anthem Blue Cross Blue Shield of Georgia prior authorization list. Not a coverage or referral decision.

Code: 0417T
Description: Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, including review and report, implantable cardiac contractility modulation system
Source: Standard Local Prior Authorization Code List, Pg 138 Original policy

Anthem Blue Cross Blue Shield of Georgia prior authorization

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